Office of Admissions

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Intent to Enroll Form Southern Wesleyan University _____Yes, I plan to enroll at Southern Wesleyan University. My $200.00 tuition deposit is enclosed. _____My enrollment plans are uncertain at this time. Please reserve my space in the class until the incoming class is full. _____Thank you, but I do not plan to enroll at Southern Wesleyan University. I will be attending ____________________________________________________. Please complete the section below for tracking purposes: Name: _______________________________________________________ Address: _____________________________________________________ City: _________________________ State: ______ Zip: _______________ If you would prefer to provide your tuition deposit by credit card, please complete the information below. The tuition deposit is $200.00 and will be applied to your account at the start of the semester. Tuition deposits are refundable up to May 1 for the fall semester and up to December 1 for the spring semester. Name on Credit Card: ___________________________________________________________ Student Name: _________________________________________________________________ Billing Address: _________________________________________________________________ City: __________________________ State: _________ Zip Code: _____________________ Telephone: _____________________________________________________________________ Card Type:

 Visa

 Mastercard

 Discover

Card Number: ________________________ Security Code: ______ Expiration Date:_______ Signature: _____________________________________________________________________ Security Code is the 3 digit code on the back of your credit card. The information above is only shared with our business office and is kept in a secured office. You can also pay over the phone by calling 1-877-644-5556 (toll free).